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Dear Mr. Holter,
I am a student in KINE 4806 taught Mrs. Cox and she has given my class a writing assignment. The purpose of this writing assignment is to look over all of your health data that has been collected in the East Carolina University FITT lab and explain to you your results, and how those results translate to possible disease that you could get in the future if you do not start making lifestyle changes now. The advice given to you in this assessment is not a replacement for regular medical care. I encourage you to follow up with your physician’s for routine medical check-ups. In this paper I will go over your results from all of your assessments. I explain to you what health range you are in and where you want to be at. I will go through the different section that you were assessed in body fat percentage, VO2 max, aerobic fitness level, your full blood panel, waist girth, and more. I want to let you know that it was such an amazing decision you made to get evaluated and begin an exercise program you are going to get so many amazing benefits from making this choice. You have taken the first steps to having a longer, healthier, more active lifestyle. That’s why in this paper I am going to explain what metabolic disease you are at risk for, if any. Like type 2 diabetes, metabolic syndrome and coronary heart disease. I will also let you know to where your number need to be to decrease the risk of you having these health problems. Again, you are already one step closer to being a healthier you. I’m so happy that you took the chance to improve your health.

Variable Values 2017 Recommended/Normative Ranges
Height (in) 77″ Weight (lb) 230 BMI (kg/m2) 27.3 18.5-24.9
Waist Girth (inches) 42.75 <40
Percent Fat 33.8% 21-23%
Blood Pressure (mmHg) 130/76 <120/<80
Resting HR (bpm) 71 60-100 is normal
Cholesterol (mg/dL) 163 > 200
LDL-Cholesterol (mg/dL) 83 0-99
HDL-Cholesterol (mg/dL) 45 <40
Triglycerides (mg/dL) 177 < 150
Glucose (mg/dL) 100 65-99
Treadmill time (mm:sec) 13:32 Maximal Heart Rate 166 220-Age
VO2 (ml/kg/min) 34.65 34.5-30.5
Aerobic fitness Level GOOD 34.5-30.5
Looking at your results your body mass index (BMI) is 27.3 kg/m2. BMI is calculated by dividing your weight in kilograms by your height in meters and then squaring that number. BMI estimates your body fat by using your height and weight. You are currently in the overweight BMI range 25.0 kg/m2 -29.9 kg/m2. The BMI range that you want to be in to be considered normal is 18.5 kg/m2 -24.9 kg/m2. You could achieve this by increasing your physical activity and losing 20 pounds. Waist girth is the circumference from your hip bone all the way back around to the same hip bone with even tension. Your waist girth is 42.75″. The recommendation is for men to have their waist girth under 40″ because carrying fat in the abdomen increase your risk for metabolic syndrome and type 2 diabetes. In the Journal of Applied Physiology there’s a study that shows, “The importance of visceral fat and its associations with risk factors for coronary heart disease and Type 2 diabetes have been well established” 3. Based on the DEXA scan your total body fat percentage is 33.8%. The recommended range for men your age is between 21 and 23%. If you were to increase your exercising you would be able to decrease that percentage by turning your fat into muscle. Blood pressure is measured as the pressure of blood within the arteries. Your resting blood pressure is 130/76. The recommended blood pressure is 120/80 becoming more physically active can decrease your blood pressure. Resting heart rate (HR) is how many times your heart beats per minute while you are sitting down doing no activity. This number can be used to show physical fitness the lower the number is the more physically fit a person is because when your HR is low that means that your heart doesn’t have to beat as many times to give your body the amount of nutrient it needs to function. Basically, your heart is beating more officially because its stronger and can pump more blood in one beat. Cholesterol is a molecule that your body need in order for your cell membrane to function correctly and if your cholesterol is too high it makes your cell membrane too rigid and unable to function like it should. Good news for you your cholesterol is in the recommended range of being less than 200 mg/dL. Your total cholesterol is 163 mg/dL. Your triglyceride level is a little high at 177 mg/dL the recommended level is under 150 mg/dL. Both your high- and low-density lipoprotein (HDL and LDL) are in the recommended range. Your HDL is 45 mg/dL and as long as its not less than 40 mg/dL you are in good shape but the higher you HDL the better. Your LDL is 83 mg/dL and the range that it needs to stay in is 0-99 mg/dL. Fast Glucose level is the amount of glucose in your blood when you have not eating this shows how well your body responds to insulin. The target range you want to be in is 65-99 mg/dL. So, at 100 mg/dL your glucose level is a little high but there is scientific proof that if you train you can increase your insulin sensitivity as shown in the graphs below. You can see that in the trained, lean individuals there was less glucose in the bloodstream and less glucose the bloodstream. Increasing your insulin sensitivity will decrease the amount of glucose in your blood.

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Maximal heart rate is how high does your heart rate go before you need to stop exercise. The equation that is used to find the max heart rate is 220- age which in your case would give us 156 bpm but, because you did the Balke treadmill test which is a maximal stress test we found that your actual max HR is 166 bmp, 10 beats higher than predicted. VO2 max is the maximum amount of oxygen a person can utilize during intense exercise. Your VO2 max is 34.65 ml/kg/min and the recommended amount is between 34.5 to 30.5 ml/kg/min. With your VO2 max this means your oxygen utilization is good for your age and you’re in the 75th percent tile. Your VO2 max directly correlates to your aerobic fitness level since you’re in the 75th percent tile this mean your aerobic fitness level is good.

Coronary heart disease (CHD) is the leading killer for both women and men worldwide 1. It occurs when the blood vessels that supply nutrients to the heart are damaged. The damage causes a cholesterol-containing deposit or plaque to form. When plaque builds up in the coronary arteries it decreases blood flow to the heart. Symptoms of the decrease is blood flow are shortness of breath, chest pains, light headedness, sweating, and nausea. The chest pain will feel like someone is standing on your chest this feeling can occur on the middle or left side of your chest. This pressure is usually triggered by physical or emotional stress and normally goes away after a stressful situation is over. Shortness of breath occurs because the heart cannot pump enough blood to meet the body’s needs and causes extreme fatigue with exertion. The complete blockage of a coronary artery could cause a heart attack. Classic signs of a heart attack are shoulder or arm pain, shortness of breath, crushing pressure in your chest. The causes of coronary heart disease. Overtime coronary heart disease can cause heart failure because of the hearts inability to pump enough blood to the rest of your body. This can cause difficulty breathing, fluid to build up in the lungs, swelling of the legs, abdomen or liver. If coronary artery blood flow is blocked and not restored it can cause sudden death.
727710312610500In the chart below, it shows the risk factor of CHD. Mr. Holter has three positive risk factors for coronary artery disease; age, sedentary lifestyle and obesity. Having these three positive risk factors does not mean Mr. Holter has CHD or will even get CHD, but it does put him at a greater risk for developing the disease. Mr. Holter is unable to modify his age but, if he can get his waist circumference under 40″ and become more active by participating in moderate physical activity for 3 to 5 days per week for 30 minutes or more he can reduce his risk factors for CHD down to one. Mr. Holter only has 3 out of the 8 risk factors. His has no immediate relative that has had a heart attack, bypass surgery or sudden death before the age of 55, he doesn’t smoke cigarettes, have hypertension, dyslipidemia, or diabetes.
Type 2 Diabetes is also referred to as adult-onset or noninsulin-dependent diabetes, is a disease that affect the way your body metabolizes inulin 6. In this type of diabetes, the body is making insulin, but the body is either resisting the insulin its making or its not making enough insulin for the body to regulate its glucose levels. Insulin is a hormone that is made in the pancreas, a gland that is situated behind and below the stomach. The pancreas secretes the hormone insulin into the bloodstream. Insulin enables sugar to enter into your cells lowering the amount of sugar that is in bloodstream. As the amount of sugar in your blood stream drop so does the amount of insulin secreted from the pancreas. Glucose is a sugar that your muscles and other tissues in your body use for energy. Glucose comes from your liver or the food you eat. The glucose is absorbed into the bloodstream and the insulin secreted by the pancreas helps the glucose get absorbed into the muscles or tissues. In type 2 diabetes this process do not work well. Sugar builds up in your blood stream instead of being moved into your cells. As the sugar in your bloodstream increases the pancreas secretes more sugar but eventually the pancreas cells cannot make enough insulin to meet your body’s demands. Although there is not cure for type 2 diabetes there are way the it can be managed. Type 2 diabetes can be managed by exercising, eating well, and maintaining a healthy weight. If exercise and diet are enough to regulate your blood sugar than you might need diabetes medications or insulin therapy. The symptoms of type 2 diabetes usually develop very slowly, so slowly that you could have type 2 diabetes for years and not know it. Increased thirst and frequent urination are symptoms of type 2 diabetes this is caused from the excess sugar building up in your bloodstream causing fluid to be pulled out of the tissues and in return you are thirsty. You then will drink more liquid causing you to need to urinate more than usual. Another symptom of type 2 diabetes is increased hunger. This is caused by your body not properly moving sugar into your cells and your organ and muscles. Your organ and muscles want the energy that sugar provide them. This is what triggers intense hunger. One odd symptom of type 2 diabetes is weight loss. Even though you are eating more than you usually would you might still lose weight. This occurs because the glucose is not being metabolized which forces your body to use other fuel sources like muscle and fat. All the excess glucose is released in your urine. Fatigue is another symptom of type 2 diabetes. Your body does not have the amount of sugar it craves so you become tired and irritable. Blurred vision is a symptom this happens if your blood sugar gets too high, fluid may get pulled from the lenses in the eyes causing an inability to focus. A very common sign of type 2 diabetes is slow healing sores paired with frequent infections. The disease affects the body’s ability to heal and fight off infections. People with type 2 diabetes will have patches of dark velvety skin in creases and folds of the body usually at the armpit or neck6. This may be a sign of insulin resistance. Having type 2 diabetes can have many consequences on your body. Since diabetes is a risk factor of CHD, having diabetes may cause you to have a stroke, chest pain, high blood pressure, narrowing of the arteries (arthrosclerosis), or and heart attack. You may also experience nerve damage because of type 2 diabetes. The excess sugar in the bloodstream because of the insulin resistance can cause injury to the wall of tiny blood vessels called capillaries that nourish the nerves in your body but especially the nerves of the legs. The injury to the capillaries can cause burning, numbness, tingling, or pain that start at your toes or finger and spreads upward. If your blood sugar is not maintained well this damage to the nerves can cause you to lose sensation in the affected limbs. If the nerves that control digestion are damaged this can lead to problems like constipation, diarrhea, nausea, or vomiting. In men erectile disfunction could be a problem as well. There are many of tiny blood vessel clusters, in the kidney, the filter waste from your blood. This delicate filtering system can be damaged by diabetes and if the damage is severe enough this could lead to kidney failure that often need to be treated with dialysis or a kidney transplant. Eyes also have blood vessels that are affected by diabetes. When the blood vessels in the eyes are damaged this could lead to blindness. There is also an increased risk of glaucoma and cataracts with diabetes. It is not confirmed that Mr. Holter has diabetes, but he did have a fasting blood glucose of 100 on one occasion.

Metabolic syndrome encompasses a lot of different conditions like increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal triglyceride and cholesterol levels 2. All of these conditions occurring together increases the risk of you having diabetes, stroke, or heart disease. If you just have one of these condition that doesn’t mean that you have metabolic system, but it still does increase the risk of you having a serious metabolic disease. The more conditions you have the higher you risk is for disease. Most conditions of metabolic syndrome have no symptoms but, waist circumference can be observed as well as if you are experiencing high blood pressure you might be have some sign and symptoms of diabetes as listed above 4. Metabolic syndrome is linked closely to being sedentary and overweight or obese. It’s also linked to insulin resistance. Like in diabetes the cells do not respond normally to insulin and glucose cannot enter the cell with ease cause more glucose to be in the blood stream and pancreas secretes more and more insulin to try and regulate the high blood sugar.
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Risk factors of metabolic syndrome are listed in the chart above. Mr. Holter has a waist circumference of 43″, a triglyceride (TG) level of 177 mg/dL, a HDL cholesterol level of 45 mg/dL, a blood pressure of 130/76 mm Hg 5, blood glucose level of 100 mg/dL. As show in the chart to have metabolic syndrome you only need to have 3 of the 5 risk factors. Mr. Holter has 4 of the 5 risk factors. Meaning he has metabolic syndrome because met or exceeded the defining level for waist circumference, triglycerides, blood pressure, and blood glucose, but he did have a good HDL level.

Bibliography
1. “Coronary Heart Disease.” National Heart Lung and Blood Institute, U.S. Department of Health and Human Services, www.nhlbi.nih.gov/health-topics/coronary-heart-disease
2. “Metabolic Syndrome.” National Heart Lung and Blood Institute, U.S. Department of Health and Human Services, www.nhlbi.nih.gov/health-topics/metabolic-syndrome.

3. Slentz, C. A., Aiken, L. B., Houmard, J. A., Bale, C. W., Johnson, J. L., Tanner, C. J., . . . Kraus, W. E. (2005). Inactivity, exercise, and visceral fat. STRRIDE: A randomized, controlled study of exercise intensity and amount. Journal of Applied Physiology, 1613-1618. doi:10.1152/japplphysiol.00124.2005
4. Owen, N., Sparling, P. B., Healy, G. N., Dunstan, D. W., & Matthews, C. E. (2010). Sedentary Behavior: Emerging Evidence for a New Health Risk. Mayo Clinic Proceedings, 85(12), 1138-1141. doi:10.4065/mcp.2010.0444
5. Riebe, Deborah, et al. ACSM’s Guidelines for Exercise Testing and Prescription. Wolters Kluwer, 2018.

6. “Type 2 Diabetes.” American Diabetes Association, www.diabetes.org/diabetes-basics/type-2/.

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